Childhood Maltreatment in the Migraine Patient
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Maltreatment during childhood increases vulnerability to a host of health disorders, including migraine. Putative mechanisms linking maltreatment and migraine include stress-induced dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, as well as disruption of other stress-mediating homeostatic systems, including those involving endocannabinoids, monoamine neurotransmitters, oxytocin, and inflammation. Prolonged elevation of glucocorticoids alters the neural architecture of the limbic system, resulting in the structural as well as functional changes described in both maltreatment and in migraine. Although treatment trials for migraine have not stratified participants by abuse history, strategies, such as cognitive behavioral therapy, which alter stress responsivity, may be particularly effective in this subgroup. Some therapies involving the endocannabinoid, serotonergic, oxytonergic, and inflammatory systems are under investigation for migraine. Anti-epileptic drugs such as valproate and topiramate, which are FDA approved for migraine treatment, are also known to interfere with epigenetic changes induced by stress. Discerning the role for this mechanism in treatment of maltreated migraineurs may introduce another therapeutic avenue.
KeywordsChildhood maltreatment Abuse Adverse childhood experiences Stress Migraine Genetics Epigenetics Inflammation Serotonin Oxytocin Hypothalamic–pituitary–adrenal axis Cognitive behavioral therapy
Compliance with Ethical Standards
Conflict of Interest
Stuart A. Collins declares that he has no conflict of interest.
Gretchen E. Tietjen holds common stock in Johnson & Johnson and Stryker.
Dawn C. Buse is an advisory board member of Eli Lilly and has received research support from Allergan Pharmaceuticals, Dr. Reddy’s Pharmaceuticals, and Avanir Pharmaceuticals.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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